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AAPA's Reimbursement Seminars
The next AAPA reimbursement seminar will be Thursday, May 29, 2008, in San Antonio!
Who Should Attend? Physician assistants, physicians, billing and coding professionals, and practice managers.
The American Academy of Physician Assistants (AAPA) is a recognized leader in reimbursement issues regarding PAs.
Learn the answers to these important questions and more!
- How can my practice maximize revenues by proper billing for medical and surgical services provided by PAs?
- When should "incident to" billing be used?
- What are the most effective strategies for optimizing practice revenues?
- When must the PA's provider number be used?
- How can I minimize the risk of fraud and abuse allegations?
- What strategies are more effective when contesting and reversing denials?
- How can I minimize my risk of non-compliance by learning about Medicare, Medicaid, and private payer regulations?
- How do private insurance companies and managed care organizations cover medical and surgical services provided by PAs?
This is a hands-on seminar, so bring your questions and issues for discussion.
For program information, call Michael Powe, 703/836-2272, ext. 3211, or e-mail michael@aapa.org.Cost:
$250 if also registering for the AAPA annual conference.
$375 if not registering for the conference.Cost includes breakfast, lunch and the seminar workbook.
Distinguished Program Faculty Emily Hill, PA-C, President of Hill & Associates, has a broad professional background in the health care industry. Her clinical, administrative, and consulting experience gives her a unique perspective in advising healthcare providers and their staff in medical practice management. With more than nine years of experience as a health care consultant, she has worked with numerous academic and private practices on coding, reimbursement, compliance, and practice management issues. Ms. Hill has taught coding seminars for a number of medical specialty societies including the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the American Academy of Pain Medicine. She is a frequent speaker for state associations, national health systems, and numerous medical practices. She currently serves as a representative on the American Medical Association's Correct Coding Policy Committee and the Health Care Professionals Advisory Committee Review Board for the Relative Value Update Committee (RUC). She also serves on a technical advisory work group for CPT and RUC issues for the American Academy of Family Physicians Commission on Health Care Services. Ms. Hill was also selected to participate in the American Medical Association's CPT-5 Project and on a Clinical Practice Expert Panel for the Centers for Medicare and Medicaid Services (CMS) Practice Expense Study. Ms. Hill provided direct patient care as a certified Physician Assistant for a family practice group and is a diplomate with the American Board of Quality Assurance and Utilization Review Physicians. She is a graduate of the Bowman Gray School of Medicine Physician Assistant Program.
Ron Nelson, PA-C, AAPA past president and president/CEO, Health Services Associates, Inc., and HSA Consulting Group, Inc. Mr. Nelson has provided management, financial, and consulting services to hundreds of practices throughout the United States. He is clinical director of Community Care of Michigan and serves on the faculty of the Central Michigan University PA Program. Mr. Nelson also previously served as president of the Michigan Academy of Physician assistants, is a former gubernatorial appointee to the Michigan Board of Osteopathic Medicine, and was twice honored as Michigan's Outstanding PA of the Year. He is co-founder and past president of the National Association of Rural Health Clinics, Inc., and is a frequent speaker on issues of reimbursement, managed care, and health system development.
Thomas L. Sparks graduated from Oakland University where he received his B.A., in 1970. He attended the University of Detroit School of Law where he received his Juris Doctorate degree in 1975. He received his M.B.A. in marketing from Michigan State University in 1985. Mr. Sparks was admitted to practice in Michigan in 1975 and in New York in 1984. From 1975 through 1988, Mr. Sparks served as an Assistant Attorney General for the State of Michigan where he represented and litigated matters for state agencies governed by the Michigan Public Health Code. His practice includes health care law, professional licensing, administrative litigation, regulatory compliance, contracts and joint ventures, Medicare and Medicaid fraud, right to die issues, peer review, pharmacy and institutional licensing, and certificate of need matters. Mr. Sparks also serves as a fair hearing officer in medical staff cases. Mr. Sparks has been appointed as a Special Assistant Attorney General for provider reimbursement matters. Mr. Sparks was admitted to the U.S. Supreme Court, and the U.S. District Court, Eastern and Western Districts of Michigan. He has been a frequent lecturer on the business and regulation of health care providers and served on the Governor's Prescription Abuse Data Synthesis Committee. Mr. Sparks is a co-author of Judicial Review of Administrative Decisions.
Michael Powe is the Director of Health Systems and Reimbursement Policy for the American Academy of Physician Assistants. In that capacity he deals with managed care, regulatory agencies and third-party payment issues. Mr. Powe also serves as the AAPA's staff liaison to the American Medical Association's Health Care Professionals Advisory Committee which evaluates the CPT coding and the Medicare payment process for certain nonphysician health care providers. Before joining the AAPA, he spent eight years in the private insurance industry with New York Life Insurance Company. Mr. Powe is the author of the publication Physician Assistant Third Party Coverage and has written numerous chapters and articles on the subject of reimbursement and coverage policy for physician assistants.
Coding & Documentation Knowing the rules and regulations for covering medical services delivered by PAs is only half the battle. If you don't properly code and document these services, your practice won't receive the reimbursement that has been earned.
Coding and documentation compliance have risen to the top of the CMS list of items to monitor. This session will give you the most up-to-date information on the recent activity in the area of E/M documentation guidelines.
- Can you use the 1995 or 1997 E/M guidelines, and which are best for your practice?
- Do you know the key components used to determine medical complexity?
- Is there value in using a template to assure proper documentation? Will it be accepted by CMS?
Effective Strategies for Dealing With Private Payers & Managed Care Organizations If you want to understand how private insurance companies and managed care organizations think about covering medical services provided by PAs, this session is a must. Often, the rules that they use to cover or deny claims are unofficial and unwritten. Who you talk with in the organization and how you ask the question will often determine whether you get a positive answer regarding coverage policy.
- Understand that there are often variations in coverage policy by the same company in different parts of the country, and how that can be used to your advantage.
- Learn what words and phrases to avoid using when talking to private payers.
- Know what issues are most important to private payers in this changing health care marketplace.
You will learn about strategies to use to contest and reverse denials, and why some methods work better than others. Find out what you can do to smooth the way for payment before a claim is ever denied.
Productivity - Understanding Your Economic and Non-economic Value to the Practice More scrutiny is being placed on the "value" that health care professionals bring to a practice. As third party payers attempt to further reduce reimbursement for services, there is greater emphasis on determining how "cost effective" PAs are to their employers. Learn ways to answer the question, "How valuable are you to your practice?"
- What is the most important attribute that PAs bring to a practice?
- What factors influence my financial value to the practice?
- Discuss non-economic values such as increased access, patient satisfaction, and physician quality of life issues
- How can I assess my economic value to the practice?
Medicare Update In this session, you will be given a copy of the official regulations from the Centers for Medicare and Medicaid Services (CMS) (formerly the Health Care Financing Administration) dealing with PA coverage and reimbursement, along with both written and verbal interpretations of the often difficult-to-understand official, bureaucratic language. Learn where to find specific rules in the Medicare Carriers Manual so you won't be at the mercy of your local carrier's "interpretation of the moment" for guidance.
- Understand when the "incident to" method of billing (at 100% of the fee schedule) can be used and what requirements have to be in place to pass CMS scrutiny
- Know when the PA's (not the physician's) provider number must be used
- Learn when and how to use modifier codes, and which modifiers CMS has discontinued
- Not billing for legitimate medical services can cost your practice thousands of dollars in uncollected revenue. Failing to understand the legal rules and requirements can lead to severe penalties being assessed and claim dollars being taken back. You have an obligation to protect yourself and your practice by knowing the facts!
Avoiding Fraud & Abuse Pitfalls A leading health care attorney will explain why the Justice Department and CMS are spending millions of dollars to identify those practitioners and practices that do not adhere to federal guidelines regarding payment policy, nonphysician employment status, and a host of other issues. Recent changes have expanded what PAs can do in the practice, but that expansion comes with additional rules and sizable penalties for noncompliance.
- What is your responsibility if you discover that services are being improperly billed?
- What are the basic safeguards in establishing a billing compliance plan?
- What penalties may be assessed if services are improperly billed?
- Find out about qui tam "whistleblower" cases and how to prevent your practice from being a target. Stark II requirements detail business and referral relationships that should be avoided. Learn which aspects of the physician/nonphysician relationship are directly affected by Stark II.
View the Thomas L. Sparks presentation
"Avoiding Fraud and Abuse Allegations"
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Additional Bonuses for Attending
- The Reimbursement Workbook - An "all you need to know" guide to reimbursement for PAs.
- Certificate of Attendance
- Accreditation - This program is provided by the American Academy of Physician Assistants. It has been reviewed and is approved for a maximum of 5.5 hours of Professional Category I (Pre-approved) CME credit by the American Academy of Physician Assistants. Physician assistants should claim only those hours actually spent participating in the CME activity. This program was planned in accordance with AAPA's CME Standards for Lecture-Learner Programs and for Commercial Support of Lecture-Learner Programs.
Last Revised: 09/08/05
